Candidates Diverge On Health Care Remedies

If choice is what Pennsylvania voters want in health reform, choice is what they're getting in prescriptions from gubernatorial and U.S. Senate candidates.

The 11 gubernatorial candidates and three Senate hopefuls agree that the U.S. health care system needs doctoring: Nearly 37 million Americans and 1 million Pennsylvanians are uninsured.

Also, the national tab -- at $800 billion -- consumes 14 percent of the Gross National Product and is bankrupting state welfare budgets.

But the remedies they prescribe are as diverse as potential cures for the hiccups.

Few of the candidates endorse any one of the major legislative proposals, be it that of Clinton, Casey, Cooper-Grandy, McDermott or Gramm. Also, they note, current members of Congress are working on at least two Senate bills and three House bills which will compete for consensus.

President Clinton's Health Security Act calls for universal coverage for all citizens through large purchasing cooperatives, with employers paying 80 percent of employees' premiums and federal subsidies to small companies, early retirees and people with incomes below certain levels. Gov. Robert P. Casey's plan would do much the same thing for Pennsylvania, but require businesses to pay 90 percent of employees' premiums.

Although Clinton's plan is no longer a front-runner, its principles still garner more support than others from candidates interviewed by The Morning Call. Those acknowledging broad support for it are U.S. Sen. Harris Wofford, a Democrat who co-sponsored the bill and is running for re-election; and Democratic gubernatorial candidates Lt. Gov. Mark Singel, State Rep. Dwight Evans, State Treasurer Catherine Baker Knoll and Lynn Yeakel.

The Cooper-Grandy bill, sponsored by Jim Cooper (D-Tenn.) and Fred Grandy (R-Iowa), is a more modest proposal, rivaling Clinton's plan. Instead of forcing business to pay the majority of the the national health care tab, the Cooper-Grandy bill would create insurance-purchasing cooperatives to reduce the price of a benefits package, making it more affordable.

However, none of the candidates responding to The Morning Call survey said they favored reform ala Cooper-Grandy.

The plan that garnered the second highest number of endorsements from the candidates was one proposed by Sen. Phil Gramm, a Texas Republican.

Gramm's bill requires employers to offer workers at least three choices, including their existing health insurance, an HMO or other provider, and a tax-free savings account to cover medical expenses exceeding $3,000 in a year.

Republicans supporting the savings account approach are U.S. Rep. Rick Santorum, who is seeking Wofford's seat; and gubernatorial candidates U.S. Rep. Tom Ridge, Attorney General Ernie Preate Jr. and John F. Perry.

McDermott's "single-payer" proposal would be administered by the states, with the government paying for basic benefits for all legal residents. None of the candidates polled by The Morning Call pinned their names to the proposal.

Among those running for governor, Republicans Sam Katz and Sen. Michael Fisher and Democrat Philip Valenti said they favored none of the above-mentioned health reform proposals, as did Joe Watkins, a Republican contender for U.S. Senate.

Charles Volpe, a Democratic candidate for governor, and his staff failed to respond to any of the newspaper's questions on health reform. In published reports, however, he has favored government subsidies to help the uninsured buy benefits and opposing employer mandates.

What's more important than the particular plan, the candidates emphasized, are the principles behind it.

"I don't give a damn whose name is on a final health care bill," Wofford said. "What's important is agreeing on which elements are critical to reform and how to build a consensus for action."

Wofford said guaranteeing affordable, private insurance for all Americans has to be the number one priority of health reform.

"That was Harry Truman's goal 50 years ago. It was Richard Nixon's goal 20 years ago. And it's Bill Clinton's goal this year," he said. "It's time for us to work together to achieve it."

The question is how to expand benefits to those who don't have them and can't afford them, and how to pay for it.

In the national arena, Wofford has distanced himself from the Clinton proposal, calling it too long, complicated and bureaucratic. Yet, the freshman Democrat is short on specific alterations he would make. For instance, he wants employers and employees to share the cost of health benefits, yet has set no minimum or maximum percentages.

Wofford's campaign manager said the candidate preferred not to answer questions for the Morning Call chart. Wofford also did not provide the League of Women Voters of Pennsylvania with specific viewpoints on health care, welfare reform and crime because he is unopposed in the Democratic primary.